소안구 안에서 백내장수술 후 발생한 악성녹내장 1예

Malignant Glaucoma Following Cataract Surgery in a Nanophthalmic Eye: A Case Report

목적: 소안구 안에서 백내장수술 후 발생한 악성녹내장 증례를 보고하고자 한다. 증례요약: 안축장 길이 20.51 mm인 여자가 우안 백내장수술 7일 후 악성녹내장 발생이 의심되어 유리체절제술과 야그레이저 후낭절개술을 시행하였으나 인공수정체 전방 편위와 얕은 전방이 지속되어 본원으로 전원되었다. 최대약물치료에도 안압은 38 mmHg였고, 구면렌즈대응치는 -3.88 디옵터였다. 동공차단을 배제하기 위해 레이저 홍채절개술을 시행하여 안압이 10 mmHg로 감소하고, 전방이깊어졌으나, 19일 후 안압이 39 mmHg로 상승하고 구면렌즈대응치도 -4.88디옵터로 감소하였다. 홍채절개술 부위를 막고있는 섬모체소대와 앞유리체막으로 생각되는 투명한 막을 야그레이저로 광파괴한 이후 즉시 전방이 깊어지고, 전방각은 개방되었다. 마지막방문 시 점안약제 사용 없이 우안 안압 10 mmHg였고, 구면렌즈대응치는 -0.38디옵터, 최대교정시력 1.0으로 호전되었다. 결론: 본 증례를 통하여 소안구 안에서 백내장수술과 순차적인 유리체절제술, 레이저 후낭절개술 이후에도 악성녹내장이 발생할 수있고, 홍채-섬모체소대-유리체막절개술을 통해 안압이 감소함을 알 수 있었다.

Purpose: We present a case of malignant glaucoma following cataract surgery in a nanophthalmic eye. Case summary: A 74-year-old woman with a nanophthalmic right eye (axial length 20.51 mm) underwent cataract surgery at a local hospital. One week postoperatively, she presented with a dislocated intraocular lens (IOL) and a shallow anterior chamber. Malignant glaucoma was suspected, and the patient underwent pars plana vitrectomy followed by neodymium-doped yttrium aluminum garnet laser posterior capsulotomy. Despite these interventions, the IOL remained anteriorly displaced, prompting referral to our institution for further management. Upon presentation, the patient exhibited an intraocular pressure (IOP) of 38 mmHg despite maximal medical therapy; spherical equivalent (SE) was -3.88 diopters. To differentiate pupillary block and establish a definitive diagnosis, laser iridotomy was performed; this resulted in a significant reduction in IOP to 10 mmHg and deepening of the anterior chamber. However, 19 days post-iridotomy, the IOP again increased to 39 mmHg; the SE worsened to -4.88 diopters. Slit-lamp examination and ultrasound biomicroscopy revealed a transparent membrane obstructing the iridotomy site behind the iris, consistent with a complex of disrupted ciliary zonules and the anterior hyaloid. Subsequently, photodisruption of this membrane was performed through the existing iridotomy. This intervention deepened the anterior chamber and achieved a wide-open iridocorneal angle. At the last follow-up, the patient had maintained an IOP of 10 mmHg without glaucoma medication. Furthermore, SE improved to -0.38 diopters, resulting in a best-corrected visual acuity of 1.0. Conclusions: Our case demonstrates the development of malignant glaucoma following cataract surgery and subsequent total vitrectomy and laser posterior capsulotomy in a nanophthalmic eye. Thorough irido-zonulo-hyaloidotomy demonstrated to be an effective approach for achieving significant IOP reduction.